Lining Up Options to Scramble
Next I started weighing my options. First, I had to decide if I wanted to finish medical school. That was easy. Between my loans, my parents, and my patients, I had no choice. I had to finish. Postponing graduating and taking another year would result in more financial setbacks and not necessarily strengthen my application. The "Michael Crichton" option had a certain appeal, but I knew it was pretty risky, required talent and a lot of luck to succeed. I also knew that in order to be licensed to practice in California, I needed to at least complete an internship.
Next, I considered my original specialty choice, obstetrics and gynecology. Given the previous year's odds -- 30 open spots in OB/Gyn and 200-plus scramblers -- I began accepting that I probably would not match in any of them. And even if I could, was I willing to go anywhere to sacrifice lifestyle, to leave my family, friends, and home state for a career in obstetrics and gynecology? I had chosen OB/Gyn halfway through my third year as a compromise field having been interested in aspects of internal medical and surgery. By the spring of my fourth year, with interviews completed and Match lists submitted, I was having doubts about this choice of specialty, questioning the stress level, professional liability, and obstetrics life-style. The night before the Scramble, I could find 20 reasons for changing to internal medicine and few for staying with obstetrics. So I began to create new dreams.
The best option seemed to be taking a one-year transition or preliminary position and hope that as an intern, I would have enough time to decide what to do and then apply for a residency position. I selected back-up programs in internal medicine from the list of unfilled spots.
In the pre-Internet days, Scramblers and unfilled residency programs relied on busy phones for contacting programs and fax machines for sending information and applications. (I heard of one person who actually bought a FAX machine so he wouldn't have to wait to use the medical school's machine.) I accepted a preliminary year position in a California internal medicine program, little more than two hours away from my parents, where several of my scrambling classmates had also accepted spots. By 11 a.m., just two hours after the Scramble had started, for me it was over.
Starting in 2012, SOAP replaces the Scramble.
Scramble Does Not Mean Failure
In the midst of the chaotic experience, it is important for medical students to remember that having to scramble is not a sign of incompetency. Contrary to popular belief, scrambling does not happen only to those at the bottom of their medical school class. Not matching is often the result of inadequate planning, insufficient ranking, misunderstandings about a promised position, circumstance, bad luck, a poor original specialty choice, or restrictions on location or lifestyle. Frequently it is the risk one takes in applying to a highly competitive field with too many applicants for a limited number of residency positions.
It may be difficult for many medical students to believe that something positive can emerge from a negative situation but in many cases it can.
- Programs that did not consider an applicant initially may select him/her during the Scramble. Every year, some prestigious programs do not initially fill. The applicant may get a better spot than ones he/she initially had chosen.
- Scrambling can help the applicant seriously consider other options. Another specialty may be the best ultimate career choice.
- The applicant can play a more active role in determining where to spend his/her intern year. (Not all of my classmates were as happy with their matched choice as I was with my scrambled one.)
- Scramblers can get into good residency programs and become capable, competent physicians
Reflecting on the past, I now realize that part of the reason I may have had difficulty matching was because I didn't match well with any of the existing available specialties in 1992. Many of the areas I was interested in -- integrative or complementary medicine, women's health, primary care/ambulatory medicine, palliative care, thanatology (death education), medical informatics, and the psychology of loss -- did not yet exist as specialties. These areas have only recently become recognized fields of study.
The experience of not matching and having to scramble, although at first was devastating taught me an invaluable lesson. Much as we might try, we cannot predict or control the future. That's a hard lesson, but an important one to be learned early in the professional career of a physician.
Looking back on this experience has made me realize how different my life would have been if I had matched in my original specialty choice. Not matching and having to scramble was one of the major events that helped lay the foundation for much of the work I am doing now: educating colleagues and the public in coping with loss and life-changing events and in understanding the grief response.
Facing a series of life-changing crises over the years forced me to find out who I am professionally and personally, to turn my adversities into opportunities for growth, re-evaluate my life's priorities and determine what was important for me, for my career, for my husband, and for my children. I have learned how important it is to accept what I can control and what I can't. I have been able to fulfill myself more completely than I would have it I had never faced crises. Most of all I have learned the importance of living life. John Lennon may have expressed these sentiments best:
"Life is what happens to you when you're busy making other plans."
1. Dyer KA. It's Not the End of the World. JAMA 1993;269(9):1184.
This article appears in the original longer version on the Journey of Hearts website at: http://www.journeyofhearts.org/jofh/resources/world_end
© 2002 Kirsti A. Dyer, MD, MS, FAAETS